Publication Date
8-1-2020
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-19-7059
PMID
33472219
Publication Date(s)
August 2020
Language
English
PMCID
PMC7819442
PubMedCentral® Posted Date
8-20-2020
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Abscess/complications/diagnosis/surgery, aortic valve/surgery, debridement, endocarditis, bacterial/complications, heart valve prosthesis/adverse effects, prosthesis-related infections/surgery, reoperation
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve is associated with morbidity and death. We retrospectively report our experience with a valve-sparing technique for managing this condition.
From October 2014 through November 2017, 41 patients at our center underwent surgery for aortic root abscess complicated by infective endocarditis of a mechanical prosthetic valve. Twenty (48.7%) met prespecified criteria for use of our valve-sparing technique after careful assessment of the mechanical valve and surrounding tissues. Our technique involved draining the abscess, aggressively débriding all infected and necrotic tissues, and then repairing the resulting defect by suturing a Gelweave patch to the healthy aortic wall and to the cuff of the valve.
We successfully preserved the mechanical aortic valve in all 20 patients. Two (10%) died early (≤30 d postoperatively) of low cardiac output syndrome with progressive heart failure, superadded septicemia, and multisystem organ failure. At 1-year follow-up, the 18 surviving patients (90%) were symptom free and had a well-functioning mechanical aortic valve with no paravalvular leak.
We conclude that, in certain patients, our technique for managing aortic root abscess and sparing the mechanical aortic valve is a safe and less time-consuming approach with relatively low mortality and encouraging midterm follow-up outcomes.